Preventive Care is
important to your health
Health Benefits & Coverage
What is Preventive Care?
Preventive care (sometimes called “preventative care”) is routine health care that includes screenings, services and counseling to help prevent illness, disease or other health problems. It’s covered by your plan because it can help you stay healthy and lets you know if you may develop a health problem.
Don’t let disease sneak up on you. Preventive care could save your life.
Understanding Your Preventive Care Benefits
As mentioned in your benefits booklet, many screenings and tests are covered at 100% with no out-of-pocket costs to you as part of your health plan. Use your preventive care and stop health problems before they get serious.
- Screenings and tests
- Cancer screenings, such as colon, breast, and cervical
- Blood pressure
- Well-baby and well-child visits
- Counseling and support
- Tobacco cessation
- Alcohol misuse
- Sexually transmitted infections
- Immunizations, like the flu shot
To be covered with no out-of-pocket costs, the service must be:
- At an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
- Filed by your doctor as a preventive care visit
- Identified as preventive care under the Affordable Care Act (ACA)
What Else Do I Need to Know?
Below are examples of common services your doctor may do that are considered diagnostic and not preventive care by the ACA. If your provider files them as preventive they will be denied as not covered; these services should be filed as diagnostic and will pay in accordance with your diagnostic benefit:
- Urine tests
- Hormone tests (i.e. testosterone)
- Vitamin B and D tests
- Chest X-rays
- Thyroid tests
- EKGs (electrocardiograms)
- Iron level testing
*NOTE: You should feel free to ask questions about your health. However, tell your doctor that you are there for a preventive care visit and check that your question is about preventive care before talking to your doctor about any medical problem you are having. If your question is not about preventive care, your doctor may file the visit as diagnostic (and not preventive), which may cost you money.
Sometimes you go to the doctor for preventive care and end up with a charge on your bill. You can avoid costs when you go to your appointment by following these steps:
- When you schedule your appointment, say that you want preventive care screenings and tests that are 100% covered by your plan.
- Ask if any tests or treatments done during your appointment might not be considered preventive care.
- Ask if talking about other health problems that are not considered preventive care during your appointment will lead to extra costs.
- Ask if lab work can be sent to a Blue Cross NC in-network lab to lower your costs.
The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.